Emphysematous bullae isolated on a healthy lung and primitive progressive dystrophic emphysema all belong to the dystrophic hyperlucent lung and are surgical cases. Having recalled the excellent prognosis of isolated bullae, the authors analyzed the surgical indications in the progressive dystrophic emphysema concerning 66 observations of which 52 cases were operated. They showed that surgery provided many improvements and that making a pleural adhesion during the intervention limited the bullous evolution of the disease. Results plead in favour of early interventions and wider indications.